Blue Cross and Blue Shield of New Mexico Further Expands Telemedicine to All In-Network Providers
Blue Cross and Blue Shield of New Mexico (BCBSNM) expanded our telehealth program in response to the COVID-19 crisis to provide greater access to care for our members.
We have expanded access to in-network telehealth services at no cost-share for all state-regulated, fully-insured members and for Medicare (excluding Part D), Medicare Supplement and Medicaid members, consistent with the terms of the member’s benefit plan. Employer group telehealth benefits may differ by plan.
We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.
What is covered?
Effective March 9, 2020, BCBSNM began providing access to telehealth services at no cost-share with in-network providers for fully-insured members for health care services for all medically necessary, covered services and treatments consistent with the terms of the member’s benefit plan.
This telehealth delivery method for health care services is available to eligible fully-insured and employee plan participants in BCBSNM’s PPO and Blue Choice PPOSM plans. Our Medicare (excluding Part D), Medicare Supplement and Medicaid members also have access to telehealth services. Telehealth benefits for medically necessary services are also available to eligible HMO members from providers in their medical group who offer telehealth (benefit plan requirements still apply, e.g., PCP referral requirements).
Providers of telemedicine may include, but are not necessarily limited to:
- Physician assistants
- Licensed behavioral health, applied behavioral analysis, physical therapy, occupational therapy, and speech therapy service providers
Any telemedicine visit, whether in-network or out-of-network, for services related to COVID-19 will not be subject to benefit prior authorization requirements.
Available telemedicine visits with BCBSNM providers currently include:
- 2-way, live interactive telephone communication (during this COVID – 19 emergency period) and real time audio and video consultations.
- Other methods allowed by state and federal laws, which can allow members to connect with physicians while reducing the risk of exposure to contagious viruses or further illness.
Providers can find the latest guidance on acceptable HIPAA-compliant remote technologies issued by the U.S. Department of Health and Human Services’ Office for Civil Rights in Action.
BCBSNM will reimburse providers for medically necessary services delivered via telemedicine and billed on claims with appropriate modifiers (95 and GT) in accordance with the member’s benefits for covered services.
Note: If a claim is submitted using a telemedicine code, the modifier 95 is not necessary. Only codes that are not traditional telemedicine codes require the modifier.
Telemedicine claims for insured members submitted in accordance with appropriate coding guidelines, including appropriate modifiers, for in-network medically necessary health care services beginning March 9, 2020, will be covered without cost-sharing and will be reimbursed at parity with in-person office visits during the COVID-19 public health emergency. This means that as an exception to the RVU for the billed procedure code determining reimbursement, BCBSNM will apply the higher non-facility (in-person office) RVUs when the provider bills a telemedicine place of service. As a reminder, BCBSNM does not advise providers how to bill their claims, including CPT code selection; also, employer group telemedicine benefits, and therefore cost-sharing, may differ by plan.
State and Federal Regulations
BCBSNM will continue to follow the applicable guidelines of the Office of Superintendent of Insurance and Centers for Medicare & Medicaid Services as appropriate for Blue Cross Community CentennialSM (Medicaid Plans) and Blue Cross Medicare Advantage (PPO)SM members. The New Mexico Human Services Department (HSD) has added new codes for both medical and behavioral health services for New Mexico Medicaid members to encourage the use of telephonic visits and e-visits. These codes and payment rates can be found in HSD Letter of Direction #31 .
Member benefit and eligibility assistance
Check eligibility and benefits for each member at every visit prior to rendering services. Providers may:
- Connect with a Customer Advocate to check eligibility and telemedicine benefits by calling our Provider Customer Service Center at 888-349-3706.
- Verify general coverage by submitting an electronic 270 transaction. This step will help providers determine coverage information, network status, benefit preauthorization/pre-notification requirements and other important details.
- Telemedicine is not yet a category offered currently in our automated Interactive Voice Response (IVR) phone system. For telemedicine benefits, please call our Provider Customer Service Center to request Office Visit benefits and request to speak with an agent for telemedicine-specific information.
Continue to watch the News and Updates section of the BCBSNM website for more information. For the most up-to-date information about COVID-19, visit the Centers for Disease Control and Prevention website.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.